President Clinton Delivers Commencement Address to Mount Sinai School of Medicine Class of 2010

The following remarks were delivered by President Bill Clinton on Thursday, May 13, 2010, at Mount Sinai School of Medicine’s 41st commencement ceremony at Lincoln Center in New York City.

New York, NY
 – May 13, 2010 /Press Release/  –– 

I should tell you all that you're probably wondering why you got stuck with a politician at the School of Medicine commencement. I'm here really for one reason. There is one group of graduates that I am particularly interested in, those who are getting their degrees in genetic counseling. I want someone to explain to me the significance of my being 4 percent Neanderthal. It might be an excuse for every mistake I made going back to my fourth birthday.

Well, let me say seriously to all of you, first, congratulations, and, second, thank you. Thank you for doing this work.

As I read over the degrees being given, not only those of you who will become physicians but those with PhDs in bioscience, neuroscience, master's of public health, clinical research, and genetic counseling, you are going to take America into the 21st century. You are going to deal with the problems of this country and the challenges in this country.

We are living in an interdependent world, a world in which we get lots of benefits, and you are Exhibit-A. I mean, look at this class, and you have more diversity than ever before. The majority of you are women. You are going to help us immensely, and going into a hard economy after some pretty tough years.

One of the things I tried to drum into the American people, especially when I was president, is you live in a big, open society and you can't put the walls back up. You have to have a solution, a new economic energy every eight years or so.

For the next few years we will go about working in energy, changing the ways we produce energy. It's also very important in helping us deal with our climate change.

Beyond that, I think biomedicine will be an enormous generator of untold and unprecedented, unimagined economic activities for our country.

Another big change we have to combat is inequality in America and around the world. And those of you who are involved in public health will have a lot to say about that. I'm very proud to say in just a couple of days I'm going to give another one of these speeches to a class in which one of the graduates who is getting a master's in public health is my daughter.

So I thank you for helping your country and the things you will do, and I thank you for helping to bridge the enormous gaps in inequality that are manifested in the diseases and afflictions of the poor, both here and around the world. You are going to play a major role in making sure that this century is the most interesting, progressive, and peaceful time in history.

The three biggest changes we face — I've already mentioned two of them. We live in an independent world, and what that means is divorce is not an option. We can't put the walls back up. And a lot of the political noise in our system is coming from people who feel profoundly disoriented. They think they are afflicted. They think the ground is moving under them and they don't have any purpose. They don't know whether they can stand and have the identity they had in the past.

When you see Virginia reeling with economic problems and instead of the legislators helping them with initiatives to respond to them, they bring back the Confederacy and they have no mention of slavery, does that mean they all became racist in the last month? No. It means that there are people there who are screaming for some little something that pretends to take the world back to some idealist past which never really existed. Stop the world, I want to get off.

When do you see people like Gary Varvel and Bloomsbury who had a field day saying the most important legislative priority among all the turmoil is to make sure people can carry a loaded, unconcealed weapon in Starbucks and order their cowboy latte? Is that really what this is all about? No. It's about maybe this one little thing could put my life back in control. Everything else is spinning out of control. I've been out of work for several months, and I haven't had a raise in four years.

The things that you are doing are dealing with people's health concerns for the poor, but in a larger sense, if you succeed you will be bridging these terrible divisions in our society and throughout the world.

I hope some of you will work in other countries. I spend a lot of my time working in our AIDS program, our malaria program, and now, of course, the work I'm doing now in Haiti with the United Nations and with the Haitian government. We need people who understand public health and understand how to train people and believe in their heart of hearts that intelligence and ability are evenly distributed, that the willingness to work is evenly distributed.

But structured systems, the kinds of things that brought you to this day into that seat, are not evenly distributed.In poor countries the No. 1 problem is the absence of systems, the absence of structures that give predictability to lawful people.

Just think about the things you take for granted. You'd be astonished if the air conditioner went out, the lights went out, and the microphone broke. But there are countries where people don't take any of that for granted.

We still have more than a million people spending the night in tents in Haiti. And we need people who understand how to bring what you have learned here to impact the lives of people that have the same rights that we do, to raise their children in decent health. So I hope you will think about that.

We could not be where we are today if it had not been for the million in number of doctors and nurses and paramedical people and other workers in public health who rushed to help Haiti after the earthquake and have stayed and gone back over and over and over again. Now we've got to build them a health system where they can stand on their own and care for their own people.

In the United States, fewer than 2 percent of the African-American population is Haitian, but 11 percent of our African-American doctors are Haitian. They can build their own medical system and they can have a public health system, but they need people like you who care enough to do it. And I hope all of you in your lifetime will find a way to do that.

In America our health challenges are quite different. But they reflect the general challenges of rich countries in the world. We have all the systems in the world, that's how we got there, but our systems get a little long in the tooth, and they become more interested in preserving the individual than the purpose for which they were established in the first place.

So our whole health-care system is, frankly, a mess. I would have voted for the health care reform bill had I been in congress. But it is just the beginning.

We spend 17.2 percent on health care, our relative competitors, who are all between nine and 10-and-a-half — except for Switzerland, they are at 11-and-a-half — but the disparity amounts to $200 a year. I think covering everybody is a good first step. Providing more affordable alternatives is a good first step. But we have to find a way to make health care a continually attractive career, not just for physicians, but for others, and yet rethink the delivery system and fine-tune the benefits, otherwise our equality problems within America will continue to increase.

The biggest public health problem in the country is a lifestyle problem — childhood obesity. And that, too, is a product of our system — the way we grow food, the way we market it, the way we sell it.

The parents are working and involved in their own lives and have little time to prepare their own food. The economic pressure on our schools, encouraging them to buy food for general consumption for the students and the staff that is high in bulk and calories but low in nutritional content. The school that does not have enough money for an exercise facility. These, too, are health-care issues.

So the problems with rich countries are different than with poor countries. Poor countries need systems, rich countries have them, but they become rigid and more concerned with the rigidity than the very thing that was the purpose for which they were set. They need you to help that, too.

We need Americans to feel comfortable again in the process of change. All these wacky things that are happening are people that are terrified in the face of the changes that are going on and they think they are going to lose. They feel they are in quicksand and they can't pull themselves out. So all of you need to see yourself in whatever health field you have embraced and making a positive change. And in a way, you are all in public health, even if that's not what your degree is in, because there are implications for the public interest in everything you do. What to research and what to not. What we know about the impact of policies on the general society and what we don't. So I ask you to think about that.

Never before in human history have we been so interdependent, and never before have private citizens had more power to do public good.

I bet some of you did it after the earthquake. I bet you went on to one of those telephone text numbers and gave 10 bucks to the earthquake relief.

Whatever we do in life, a big part of our future as citizens will involve more than voting. It will involve being involved in some nongovernmental effort to advance the public interest.

Today, those of us who work in health care — and my foundation sells and dispenses eight medicines in 70 countries, and we have health care operations in more than 30 countries, and I am really worried now.

For the first time in 10 years, I'm worried. Because more and more people are living with AIDS and they can't get the medicines, and the more people who live with it, the more people need medicines. Even though we are able to cut the cost by about 50 percent by using the generic drug, it's still a bigger bill. And yet, you could make a very compelling argument, as did our administration, our government has done that, the time has come to go build comprehensive health systems in these poor countries. And even with the 50 percent generic drugs, we are dealing with other diseases like malaria that costs less to deal with and kills a lot of people.

You can make all these arguments. But we are going to see real conflict over scarcer health care coverage in a way that may cause a crisis in many more countries in the world even as we try to deal with a very different source of challenges here at home. We need people like you to help us work through it.

So that's my last point. Whatever your degree is in, whatever you are doing next, whether you want it or not, you are in public health. And one of the great challenges of your age is to reduce the disparities and improve the systems by which we deliver health care.

That may mean that in addition to your job, you have to devote some time, some efforts, to nongovernmental work that will bridge the gaps that always exist between what the private sector can provide and what the government can provide. And bridging that gap will determine the world your own children will live in.

I'm still very optimistic at this point about the 21st century, mostly because of people like you. But it's very important that you realize that it has started with the right dimensions, and it's your job, whatever your other job is, whatever your specific degree is, to do what you can with the knowledge and skills that you have to build a positive world that will reduce the negative forces of our common future.

When the genome was sequenced in 2000 for the first time in my presidency — and we spent a lot of your tax money to finish that — as a non-scientist, the most interesting thing to me was the immediate conclusion that genetically, all human genomes were 99.9 percent the same.

And then Gregg Feero said, no, that's not true. We are only 99.4 percent the same. Now, with 3 million genomes that's a significant number, right? Half of 1 percent scientifically. But to a politician it doesn't sound like much.

And I do think that if we look around the graduating class at every single difference you can see, everything obvious to your eye from gender to skin color to eye color to size and shape, everything noticeable is the result of something less than one-tenth and a half percent of our genome makeup, but otherwise we are the same. Essentially, confirming all the teachings of all the great witnesses from time and memorial — that what we have in common is more important than our interests and differences.

You live in a world where you will only be able to appreciate the differences if we embrace what we have in common and act on it. I hope you will do that. If you do, you are going to have a great ride.

Thank you and congratulations.

About The Mount Sinai Medical Center 

The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of few medical schools embedded in a hospital in the United States. It has more than 3,400 faculty in 32 departments and 15 institutes, and ranks among the top 20 medical schools both in National Institute of Health funding and by U.S. News & World Report. The school received the 2009 Spencer Foreman Award for Outstanding Community Service from the Association of American Medical Colleges. 

The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation’s oldest, largest and most-respected voluntary hospitals. In 2009, U.S. News & World Report ranked The Mount Sinai Hospital among the nation’s top 20 hospitals based on reputation, patient safety, and other patient-care factors. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 530,000 outpatient visits took place. 

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